Figure Legend: Complications of boxers
fractures. Penetrating injuries of the metacarpal head from clenched
fist bite injury mechanism are frequently delayed in presentation, and
may rapidly progress to pyarthrosis and osteomyelitis. The patient
may present with infection and a trivial appearing wound (1), masking a
direct injury of the metacarpal head (2). Casual inspection of the wound
in the emergency room may be misleading because the offset of soft tissue
and joint penetration at the time of injury (3) is different than at the
time of presentation when swelling results in metacarpophalangeal joint
extension (4). Palmar angulation of the distal fracture fragment
(5) may result in tendon in balance and secondary flexion contracture of
the proximal interphalangeal joint, usually to the same extent as angulation
of the fracture malunion (6).
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